價值醫(yī)療視角下國家藥品集中帶量采購在某公立醫(yī)院的實施效果評價

趙潔 李巍 王皋俊

中圖分類號 R95 文獻(xiàn)標(biāo)志碼 A 文章編號 1001-0408（2021）19-2410-05

DOI 10.6039/j.issn.1001-0408.2021.19.18

摘 要 目的：評價某公立醫(yī)院對國家藥品集中帶量采購（以下簡稱“國采”）政策的執(zhí)行情況，以期為推進以價值醫(yī)療為導(dǎo)向的國采政策提供參考。方法：對重慶市某公立醫(yī)院涉及的國采中選的抗菌藥物共計6個品種、12個品規(guī)進行具體分析。調(diào)取該醫(yī)院國采實施前1年（即2019年4月20日-2020年4月19日）和實施后1年（即2020年4月20日-2021年4月19日）的藥品使用數(shù)據(jù)，分析其價格變化、仿制藥替代率、日均費用（DDDc）、實際節(jié)省費用等指標(biāo)，提出問題及建議，并評估國采政策實施效果是否體現(xiàn)價值醫(yī)療的核心內(nèi)涵。結(jié)果：國采實施后，該醫(yī)院中選抗菌藥物價格平均降幅為63.44%，原研藥價格平均降幅為27.38%，仿制藥替代率平均為25.59%;該醫(yī)院中選抗菌藥物的DDDc均有不同程度下降，其中4種藥物的降幅在10%～40%，鹽酸莫西沙星片降幅達(dá)到80.14%;6種抗菌藥物相較國采前共節(jié)省約52.13萬元，其中進口藥鹽酸莫西沙星片和鹽酸莫西沙星氯化鈉注射液共節(jié)省49.53萬元（占抗菌藥物總節(jié)省費用的94.97%）。結(jié)論：基于價值醫(yī)療角度的國采政策的價值主要體現(xiàn)在藥品雙通道管理機制提高了藥品可獲得性，可以有效控制醫(yī)療費用不合理增長、減少醫(yī)保基金支出，有助于進一步減輕患者用藥負(fù)擔(dān)。而目前，國采政策實施面臨的困難還包括藥品價格需回歸合理區(qū)間、外企需改變策略尋求突破、中選仿制藥與原研藥之間的質(zhì)量差異會導(dǎo)致療效差異等。為此，筆者認(rèn)為醫(yī)藥市場結(jié)構(gòu)應(yīng)正向轉(zhuǎn)變、以價值醫(yī)療助力醫(yī)保調(diào)控、優(yōu)化一致性評價體系，從而進一步提高患者健康水平。

關(guān)鍵詞 藥品;國家藥品集中帶量采購;價值醫(yī)療;實施效果

Effect Evaluation of National Drug Centralized Volume-based Procurement in a Public Hospital from the Perspective of Value-based Healthcare

ZHAO Jie1，LI Wei1，WANG Gaojun2（1. Medical and Social Development Research Center， School of Public Health and Management， Chongqing Medical University，Chongqing 400016，China; 2. Dept. of Pharmacy， First Branch， the First Affiliated Hospital of Chongqing Medical University， Chongqing 400015， China）

ABSTRACT ? OBJECTIVE： To evaluate the implementation of national drug centralized volume-based procurement （called “VBP” for short） in a public hospital， so as to provide reference for promoting VBP policy guided by value-based healthcare. METHODS： A total of 6 varieties and 12 specifications of antibiotics included in VBP in a public hospital in Chongqing were analyzed. The drug use data of the hospital one year before the implementation of VBP （i.e. April 20， 2019- April 19， 2020） and one year after the implementation （i.e. April 20， 2020-April 19， 2021） were collected and analyzed in respects of price change， generic drug substitution rate， average daily cost （DDDc）， actual cost savings and other indicators. The problems and suggestions were put forward， and the effects of VBP policy implementation whether reflects the core connotation of value-based healthcare were evaluated. RESULTS： After the implementation of VBP， drug prices fell by an average of 63.44%， the average price drop of original drugs was 27.38%， and substitution rate of generic drugs was 25.59%. DDDc of selected antibiotics in the hospital decreased in varying degrees， of which the decline of four drugs was 10%-40%， and that of Moxifloxacin hydrochloride tablets was 80.14%. Compared with bef VBP， 6 kinds of antibiotics saved about 521 300 yuan， of which the imported Moxifloxacin hydrochloride tablets and Moxifloxacin hydrochloride sodium chloride injection saved 495 300 yuan （accounting for 94.97% of the total cost savings of antibiotics）. CONCLUSIONS： The value of VBP based on the perspective of value-based healthcare is mainly reflected in the dual channel management mechanism of drugs， which improves the availability of drugs， effectively controls the unreasonable growth of medical expenses， reduces the expenditure of medical insurance fund， and helps to further reduce the drug burden of patients. At present， the implementation of VBP still faces difficulties， including the need for drug prices to return to a reasonable range， the need for foreign enterprises to change strategies to seek a breakthrough， and different therapeutic efficacy due to the difference in quality between the selected generic drugs and the original drugs. Therefore， the author believes that the pharmaceutical market structure should be transformed positively， value-based healthcare should help the regulation of medical insurance， and the consistency evaluation system should be optimized， so as to further improve the health level of patients.